Culture of Safety
Implementing Culture of Safety and Just Culture principles encourages and rewards the identification, reporting, and resolution of safety issues. It can further increase opportunities for proactive systems improvement in your organization.
The Risk Management Essentials and Introduction to Just Culture program offers an education in Just Culture principles and provides hands-on experience for clinical and support staff. This program provides staff with an introduction to the “science of safety,” promoting a systems approach to analyzing high-risk processes. The program includes discussion of accountability, reporting obligations, and the Just Culture approach to managing error and behavioral choices.
The Just Culture Leadership program offers an education in Just Culture principles and provides hands-on experience for leaders in classifying behavioral choices and applying an accountability matrix to realistic scenarios involving staff error. The program includes a methodology for spreading and sustaining Just Culture throughout the organization.
When determining accountability, Just Culture looks at human behavior and the choices we make. Human behavior is classified according to three different levels of culpability: Human Error, At-Risk Behavior, and Reckless Behavior.
In “Just Culture: Evaluating Behavioral Choices”, Cathy Miller, senior risk management specialist at CAPAssurance, describes and evaluates these behavioral choices.
A starting point for achieving a culture of patient safety is measuring the current organizational safety culture. The assessment tools are predictive measures of organizational safety culture, and help understand error, predict performance and design targeted interventions.
Developed at the University of Texas Center for Healthcare Quality & Safety, this survey tool elicits caregiver attitudes across six domains, including teamwork, safety climate, perceptions of management, job satisfaction, working conditions, and stress recognition.
Developed by the Agency for Healthcare Research and Quality (AHRQ), this safety survey is designed to help hospitals assess the culture of safety in their institutions.
Demonstrate organizational commitment to patient safety by implementing Leadership Roundings in all patient care departments. Rounds are an informal way for leaders to connect with front-line staff to discuss patient safety issues and ideas for systems improvement. Rounding is an essential feature of any robust Patient Safety Culture.
Nearly every major patient safety organization considers Rounding to be one of the best ways for leaders to demonstrate their commitment to patient safety and Just Culture principles.
In the Practical Guide to Leadership Rounds video, Cathy Miller, senior risk management specialist at CAPAssurance, offers practical advice on leadership rounding.
Leadership Rounding is endorsed by nearly every major patient safety organization as an essential means of demonstrating commitment to patient safety and ensuring the thorough integration of Just Culture principles throughout the organization.
Access the Leadership Rounding Tips
Access the Patient Safety Leadership Walk Rounds Tool (PDF) (Produced by Institute of Healthcare Improvement)
One Team…One Goal – Quality Outcomes!
At its heart, healthcare is a team sport! High functioning teams know that clear, accurate, and timely communication is essential to maximizing performance, improving patient outcomes, and decreasing risk exposure.
Whether teaching a patient about medication side effects, escalating a patient safety concern, or conducting a solid handoff to ensure the patient’s “safe passage” during a transition of care, honing communication skills and reinforcing communication protocols improve patient safety and satisfaction, while unifying the team. Everyone wins.
The Joint Commission cites communication failures as the leading root cause for medication errors, delays in treatment, and wrong-site surgeries. And it is the second most frequently cited root cause for operative, postoperative events and fatal falls.
This interactive program provides education and practice using the techniques that guarantee successful communication. The program includes: read-back, teach-back, standardized handoffs, SBAR and critical language, time-outs, as well as tips on patient-centric change of shift report and family education.
The National Patient Safety Foundation’s Lucian Leape Institute is charged with defining strategic paths and calls to action for the field of patient safety.
Download (The National Patient Safety Foundation's Lucian Leape Institute)